In Catalonia, Health IT Governance Rises Above the Political

June 11, 2018
The leaders of the TICSalut Foundation, the government agency that manages healthcare IT management and development for the entire region of Catalonia in northeast Spain, are moving forward on a broad range of fronts

Those who have been following the political scene in Spain lately know that the politics around the independence movement in Catalonia, that country’s wealthy northeast region, has become very intense of late. Certainly, the debate around the future of Catalonia remains heightened and controversial.

But beyond the news headlines, Catalonia (in Spanish, Cataluña; in Catalan, Catalunya)—whose land mass of 12,400 square miles is about the size of the state of Maryland, but whose population of 7.5 million is closer to that of Virginia—is a region noted for its economic and cultural vitality and ingenuity.

What’s more, because of the governmental landscape in Spain and Catalonia, healthcare information technology is in some ways very well-situated in terms of its overall governance. As in nearly all of the western European nations, healthcare is largely government-run in Spain. What’s more, Spain is governed through an architecture of autonomous regions, including Catalonia, which is governed by its own Parliament and regional government, the Generalitat de Catalunya.

Under the governmental architecture of the Generalitat is the Ministry of Health of Catalonia, and, managing the healthcare information technology resources of the Ministry of health, is the TICSalut Foundation. As the TICSalut Foundation’s website explains, “The TicSalut Foundation is an agency within the Ministry of Health that works to promote the development and use of ICT and networking in the field of health, acts as an observatory for new trends, innovation and monitoring of emerging initiatives and provides services for the standardization and accreditation of products. The implementation of ICT in the health sector is now unstoppable and is seen as one of the most transformative elements in the health sector of the future. The fact that the health sector in Catalonia covers 100 percent of citizens within a framework of universal and public coverage, together with the involvement of a variety of agents, organizations, suppliers and subsidiary industries, puts the health sector in an excellent position to act as an economic innovator and energizing influence in the use of new technologies.”

Late last year, Healthcare Informatics Editor-in-Chief Mark Hagland met with Francesc Garcia-Cuyàs, director of the TICSalut Foundation in Barcelona, to discuss some of the innovations taking place in Catalonia, and his perspectives on the Catalan, Spanish, and European healthcare IT development issues, and the comparisons between the Spanish and American situations, with regard to interoperability, health IT investment, and systems integration. Below are excerpts from that interview.

Mr. Garcia-Cuyàs, please tell me a bit about the governance and management aspects of the healthcare system in Catalonia, with regard to healthcare IT development and management?

In the Catalan healthcare system, each hospital has its own information system. But over the course of time, we have been creating full interoperability among all the hospitals in the region. We began an intensive IT harmonization initiative in 2006, and have been evolving it forward ever since.

We have developed a regional plan for digital health, a strategy for healthcare delivery, and for informatics. Our philosophy is that the technology must serve to support specific projects, as well as supporting digital transformation, and the patient experience, among other priorities. Our overall system encompasses both primary care information systems and medical specialty-based systems. And every hospital and outpatient center is able to share electronic health record-related data in our repository; all our hospitals, primary care clinics, and specialty medical practices, are connected. We have a national healthcare system that provides complete integration of EHRs, and allows for nationwide data-sharing, as appropriate. What’s more, all our local and patient care organization repositories are connected. Also, we’ll be moving everything to the cloud soon.

Meanwhile, in Catalonia, we’ve got 7.4 million patients in our regional system, with 18 percent of them over the age of 65, and 2 percent living with at least one chronic illness.

Francesc Garcia-Cuyàs

Tell me about some of the more advanced capabilities in your system?

Yes, we’ve got electronic prescribing, and pharmacy automation, including an integrated electronic prescription system across the entire nationwide healthcare system. What’s more, patients can check their personal electronic health records from their smartphones. We have all test results stored in our EHR. One of our goals is to be as people-centered as possible. We believe that by giving patients relevant information, they will participate in working to improve their health status.

Would you say that the overall regional health information system in Catalonia is one of the most advanced in Spain?

Yes, it really is; Catalonia has advanced faster than some of the other regions here; in fact, other regions are busy copying what we’ve been doing here.

What have been and continue to be, the biggest challenges for you and your team, in managing this very large regional health information system?

There are two. The first is helping our providers to manage the care processes of our citizens who are living with chronic illnesses. The other is moving forward into leveraging artificial intelligence-based tools, particularly to participate in robust data analytics.

But you have been moving forward in that area?

Yes, we have; we’ve been moving forward into predictive analytics, for example. Predictive analytics will be very helpful in a number of areas. We have an office of artificial intelligence, and we’re moving into the use of both machine learning and deep learning. One of our goals is to help to facilitate the success of a number of specific projects in our healthcare system, and to help individuals working on those projects to integrate their use of AI tools into their work. For example, we’re currently working on a report on our progress as healthcare system around care management. AI would be very helpful in that work.

What are something the projects you and your team have been working on recently?

We’re making progress in areas such as the expansion of the use of electronic signatures, and we’ve got three pilot projects moving forward in that area and others.

Have you achieved barcoded medication administration yet?

Yes, that exists. One element that is helpful in that regard is that the dispensing of prescription pharmaceuticals is highly regulated in Catalonia. Only official pharmacies are allowed to dispense medications; it’s not like in the United States, where commercial drugstores have pharmacies. Our pharmacies are state-controlled. Those kinds of commercial drugstores are allowed only to sell over-the-counter medications.

What might happen in the next few years?

We hope to be able to articulate a strategy to introduce more technology into the social sector. In fact, we have an office dedicated to research in that area. Things like some kind of digital café, and other resources that would create greater patient/healthcare consumer engagement around educating patients about their medications, and so on.

What have been some of the learnings on the journey forward so far?

One has been that, in developing new technologies, we need to work closely with physicians and nurses, in order to develop optimal solutions. Digital care is complex, and clinicians need to be part of determining what works and what doesn’t.

Sidebar: Digital Transparency in Catalonia

In one section of its website, the healthcare administration of the regional government of Catalonia, the Generalitat, includes this information about digital data transparency and access in Catalonia:

“The Government of the Generalitat de Catalunya has committed itself to the opening of public data, with the aim to make them transparent to the public, in addition to promote the use and re-use of the information generated by the Administration. The data are grouped in a common portal according to the standards promoted by the International World Wide Web Consortium (W3C). The “Open Data Gencat” project follows international trends around open data and navigation, according to the appropriate boundaries around privacy, security, and property that apply in each case, according to the Government Agreement of November 2010.

The Department of Health of the Generalitat is working for many of the data collected from the Observatory and other health interests to continue the process of opening in a coordinated manner with the Gencat portal, where you can see all the files available related to health issues. The files released allow, in addition, for the development of data visualization tools, and for the ongoing monitoring of the ongoing progress of DiagnostiCat, a portal of the Catalan Institute of Health that shows almost in real-time data for diagnostics of diseases that are presenting in a large majority of primary care centers in Catalonia.”